HomeMy WebLinkAboutMiscellaneous - 40 WOODBRIDGE ROAD 4/30/20180
PO Box55098
Boston, MA 02205-5098
- _ . 61.7-951 9600
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
City Hall
N ANDOVER, MA 01845
Board of Health or
Board of Selectman
City Hall
N ANDOVER, MA 01845
RE: Insured: STEPHEN J NOONE and JULIE A NOONE
Property Address: 40 WOODBRIDGE RD, N ANDOVER, MA
Policy Number: HMA 0249470
Claim Number: BOS00055317
Date of Loss: 3/11/2015
Company: Safety Indemnity Insurance Company
Claim has been made involving loss, damage or destruction of the above -captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be
applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer and include a reference to the captioned insured, location,
policy number, date of loss and claim number.
David McDermott Claim Examiner 3/13/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3537
Fax: (617) 603-4866
Email: DavidMcDermott@Safetylnsurance.com
WOR TM
11 6
TOWN OF NORTH ANDOVER
O P
1
PERMIT FOR GAS INSTALLATION
'Is9SSAc HUSEt1 --.
This certifies that.f!a.L, tE?.!?��....... ........... • .
has permission for gas installation ..Cr : ?. r..!. .................
in the buildings of ..................................
at ...y p .. I'ap'o: e-1. .6 et Jr� c7..` ...... . , North Andover, Mass.
Fee. �� a . - .. Lic. No.. )Y.Y :,o.... .... .�� .. ...... .
GASINSPECTOh
Check #
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MASSACHUSETTS UNIFORM APPLICAT
(Print or Type)
Mass. ate
Building Location tt) OO d I
M
FOR PERMIT TO DO GASFITTING
2(- O�( Permit # O
f "Owner's Name
Type of Occupancy
New pr Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑
Installing Company Name L A LLQ/ -1114- C Check one: Certificate #
Address �% / 1� l: Ll9dlV� C3 orporation
rU- /�Lt�(JUu ❑ Partnership
Business Telephone C(7 �, , ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter �v c/ALL �ii¢,C
INSURANCE COVERAGE:
have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ee' No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A Ilabllfty Insurance policy-� Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ Agent ❑
Signature of Owner or Owner's Agent
hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be I mpIla ce lh ali
pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of th7Ge,.,ral laws.
B' Type of License:
Title Plumber ure o ense Plumber or Gas rtter
asfitlor
aster license Number
City/Town Journeyman
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MEMO
MINES
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NEENIONNIONE
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Installing Company Name L A LLQ/ -1114- C Check one: Certificate #
Address �% / 1� l: Ll9dlV� C3 orporation
rU- /�Lt�(JUu ❑ Partnership
Business Telephone C(7 �, , ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter �v c/ALL �ii¢,C
INSURANCE COVERAGE:
have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ee' No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A Ilabllfty Insurance policy-� Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ Agent ❑
Signature of Owner or Owner's Agent
hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be I mpIla ce lh ali
pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of th7Ge,.,ral laws.
B' Type of License:
Title Plumber ure o ense Plumber or Gas rtter
asfitlor
aster license Number
City/Town Journeyman
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Location`
No. /C Date 3 " �O
NORTH TOWN OF NORTH ANDOVER
Of «to ,a 1ti
` p
a ; ; Certificate of Occupancy $
�'�s''•a°'t<�' Building/Frame Permit Fee $
SAC�NIs
Foundation Permit Fee $
Other Permit Fee $ `7
TOTAL $ ya, rd
Check N13691
/ Building Inspec`_tor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
�i
BUILDING PERMIT NUMBER: DATE ISSUED:
s
SIGNATURE:
jq!i1ding Commission /I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
4
Map Numb Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions -
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required
Provided
1
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information_
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System.. 0
SECTION 2 - PROPERTY OWNERSIRP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address fo.' Sergi itie ;
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
�i S `� C` :C
Not Applicable ❑
Company Name
f � e--
Address
J J^%c l l� i
Registration Number
Expiration Date
nature Telephone
61L
0
SECTION 4 - WORKERS COMPENSATION (M G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... El No ....... ❑
SECTION 5 Description of Proposed Work check an a licable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS 1
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFVICIAL USE ONLY
1. Building
,,
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) , (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SEUIMIN 7a UWNER AUlHURtZAlION TU BE CUMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES'FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize. to act on
My behalf, in all matters relative to work authorized -by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT_DECLARATION
h as Owner/Authorized Agcnt of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS IST 2 ND 3
SPAN
DIMENSIONS OF SILLS
DUVENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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The Commonwealth of Massachusetts
Department of /ndustrial_�ccldents
Office cif Investications
Boston, Mass. 02 111
Worker:,' Compensation Insurance .4,Tdavit
'lame Please Fctt I
M-
Cii Phare
I am a homeowner perrcrminc all work myself.
I am a sole proprietor and have no one INcrking in any capa&,t
CI am an employer providing workers' ccmppennsaticn for myyeemployees ,vcrkine on this job.
rmm�anv name' ��� U) Vt4
Address -6 __'J
ON: e YT_ °honer \ppo,:7 -a
Insurance An.Pelic'4 ciwc- �� (r%l`5 c\S `�Gs 5
i
Camcanv name:
Address
Cihr' Phone Y'
Insurance Co. FOlicv T
Failure to secure ccverace as recuirec under Se-: en S°.4 cr MGL 15S can lead to the impos,iicn cr cnmirel Penalties of a rine up to Si. SCC -CC
ancicr one years' imanscnment as well as c:vii penalties in the tcrm cr a STCP I/I/CRK CRCE= :rid a lire cr (S1 CO.O0) a day agairst me. I
understane that a cccy cf Chis statement may ce 'cruarcee to the Ctfice cr Invesrcaticns of :he GIA rcr ccverace vermc3ticn.
I co heresy certrry urcar the pains and penalties or ^ 7ur� that :he inrcrmaticn provided accve s :rue and cvmc:.
Sicnature '���1��1" ����.1 GdG6P --=tc
Prim name Fhcne T d 'Lia f ir,
CPlic:ai use only co not write in this area to to comcleted ty c:ty cr :awn crc:af
C'ty or Town P=rmit/LJcersirc
❑Check .r immediate response is required
Contac: person:
uu Irg ep
Licensing Ecard
salecrman's Office
Phcne .#' r health Department
C Other
C astricone Roofing & Siding
REPAIRS FREE ESTIMATES
Telephone (978) 682-4266
MARIO CASTRICONE
31 Court Street, North Andover, Mass. 01845
I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, onpre ses below descri4ed:
Owner's Name .......................,................._ ............. ,....... f ..... ........................................ I .........
- �....................................................................
Job Address...:. 4Ll....!iv.,r(r`"Z t ............................. Ci ty..... �....V.:2�%Z � . State......../..`.. ........................
...... .j�.. �
.........:'.. - ...
SPECIFICATIONS
.................................................................
...........;..................................................................................................................................................................................................................................................
......................
,,. #�!....................................................................
Materiels and labor to cost $ .. C ............... .... Payable .............and balance in............
on ...................
monthly installments of $ .........................................each, payable on ........................................day of each and every month thereafter until paid
in full (..............% charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.
Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a
completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid
immediately due and payable. It is agreed that if permitted by. law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in
addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith.
It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates
of the parties.
The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s).
PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused.
Ther6 are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this
contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed
by all parties.
Cover attic storage cleaning not included.
Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and
the coptents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and
understandings of said parties are contained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in opJrat 40' L1
IN WITNESS WHEREOF, the parties have hereunto signed their names this .......... ..... .. .... day of .. �� L ...,7..
Accepted:
Signed.... ......fir ....... ............�. ... ..............................
Owner
(OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT)
..L�-.....trz....!.. ................................
Per.... ...
Representative
Signed..........................................
Owner
Signed......................................................................................